Inter-Clinician Variability in Primary Care Providers' Adverse Childhood Experience Knowledge, Training, Screening Practices, and Perceived Intervention Barriers: an Exploratory Cross-Sectional Study.

Adverse childhood experiences (ACEs) are traumatic events that occur before the age of 18 that can have immediate and long-term negative health, behavioral, and social outcomes. Primary care providers (PCPs) can help mitigate the negative effects of ACEs by identifying at-risk children and families in need of support. This cross-sectional study, that incorporates inter-clinician variability into the sample, explored PCPs ACE knowledge, training, screening practices, and perceived intervention barriers to addressing ACEs. Results found that PCPs had limited familiarity with the ACE study and the effects of ACEs, few PCPs received training on ACEs, only some PCPs formally screened their patients for ACEs, and lack of time and training were PCPs most cited perceived barriers to addressing ACEs. A statistically significant difference in PCPs ACE knowledge and perceived barriers to addressing ACEs by inter-clinician variability was found. To more effectively address ACEs in the primary care setting, the following is recommended - effective ACEs educational tools and resources for both resident and attending PCPs, training on addressing sensitive topics including ACEs beginning in resident physician education, efficient models for ACEs office-based screening, increased access to mental health care for patients, strengthened care coordination with community organizations, and collaborative practice networks.

Shared Language for Shared Work in Population Health.

People working on behalf of population health, community health, or public health often experience confusion or ambiguity in the meaning of these and other common terms-the similarities and differences and how they bear on the tasks and division of labor for care delivery and public health. Shared language must be clear enough to help, not hinder people working together as they ultimately come to mutual understanding of roles, responsibilities, and actions in their joint work. Based on an iterative lexicon development process, the authors developed and propose a definitional framework as an aid to navigating among related population and community health terms. These terms are defined, similarities and differences clarified, and then organized into 3 categories that reflect goals, realities, and ways to get the job done. Goals include (a) health as well-being for persons, (b) population health as that goal expressed in measurable terms for groups, and (c) community health as population health for particular communities of interest, geography, or other defining characteristic-groups with shared identity and particular systemic influences on health. Realities are social determinants as influences, health disparities as effects, and health equity as both a goal and a design principle. Ways to get the job done include health care delivery systems for enrollees and public health in population-based civic activities-with a broad zone of collaboration where streams of effort converge in partnership with served communities. This map of terms can enable people to move forward together in a broad zone of collaboration for health with less confusion, ambiguity, and conflict.